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•LECTRICAL PERMIT AP•ICATION , > �_�6� <br /> CITY OF EVERETT PERMIT SERVICES �' loD <br /> 3200 CEDAR STREET, EVERETT, WA 98207 � �a7`���o <br /> (P)425-257-8810 � FA;<425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECTADDRESS: (�O lµL, t'� �t�. <br /> BUILDING AREA(d resWentiat, new construcLon,mmotlel,or addRion) 00 SF <br /> BUILDING TVPE: ❑SFR�OETACHED O SFR•ATTACHED ❑DUPLEJC ❑MULTI�FAMILY-p OF UNITS �COMMERCIAL <br /> USE OF BUILDING: Z '� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: S � pQd <br /> NUMBER OF DEVICES Ii low volta e : DO <br /> FIRE ALARM7 ❑YES NO <br /> ASSOCIATED BUILDING PERMI7 ft if a licable : <br /> DESCRIPTION OF WORK: <br /> _ � v:\� � � <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME 11 Commcrcial�: r ' J u- <br /> OWNER MAILING ADDRESS: s*nee* <br /> t'Tv sier[ 2io <br /> OWNER FHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: '�. B.[r �D�B U �V r S <br /> CONTRACTORADDRE55: smee� 9QQ S �L - � <br /> c�rv � srnrc w/F :iv q <br /> CONTRACTORPHONE:7.f7�- _ �(4� CONTRACTOREMAIL:J:�..��..sy � E,1�. Kh� � <br /> CONTRACTOR LIC.M�REOUiREO�: C� �; a CITY OF EVERETT BUSINESS LIC.NINEOUiRFO>: U <br /> PRIMARY CONTACT: O OWNER �CONTRACTOR ❑OTMER(Please Speciy) <br /> CONTACTNAME: �1 CONTACTPHONE: aVb-lb3- <br /> J"^' ��yS��e\Vl CONTACTEMAIL: ,;�, <br /> AGR[L"M[NT ThembycemyMafllwvema0an0eiammeUMrsappbcanonandknow�AesameroDenueen�cormct Allprpns�onso/Iawsan0ord�nanresgovemmg�h�s <br /> rype ol wod aUl De rompleleC wlrefher spenfie0/remm or not. The granOng of a pemrrt Ooes no10R'sume fo grve avlhonN fo nolafe or cancMf/re O�hsions o/any of�cr slalo or <br /> local law�regu�a0nq ronitru[hon or Me perlormanrn ol cronsfmchon. 1Aat I am eufhonted Dy t�e mvne�ol f��s pmpeM Io pedorm Me wod lor wlr¢�nppncalron is m2tle antll <br /> comply�(�ryiC Sfale Con(raclars Law 1877 HCW an0 796 200 WAC <br /> Gty ol Evemtt OHina/Use llnly <br /> FEE � <br /> �� o0 <br /> PERMIT# <br /> � � <br /> �. � �� - - �-��-�6 E 0 � II�(� <br /> ' wner�izea AgeM Signature Dale (Revise0 f0/77l1015J <br />